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White-Coat Hypertension: A Benign Disorder?

"White-coat hypertension" is estimated to occur in 20 percent to 40 percent of patients with presumed mild hypertension. This British study compared the long-term risk conferred by white-coat hypertension versus sustained mild hypertension for development of cardiovascular events. White-coat hypertension was defined as an elevated systolic blood pressure (BP) between 140 and 180 mm Hg in clinic that is associated with a 24-hour ambulatory systolic BP of less than 140 mm Hg and a diastolic BP less than 90 mm Hg.

Of 479 patients whose BP in clinic met the study criteria and who subsequently underwent 24 hours of intra-arterial ambulatory BP monitoring, 126 had white-coat hypertension and 353 had sustained mild hypertension. The majority of patients in both groups received antihypertensive therapy. During nine years of follow-up, 15 cardiovascular events were recorded among the white-coat hypertensives compared with 83 events among sustained hypertensives. The resulting event rates were significantly lower among the white-coat hypertensives than the sustained hypertensives (1.32 vs. 2.56 events per 100 patient-years, respectively). Patients with sustained hypertension had approximately twice the risk for coronary events and at least four times the risk for a cerebrovascular event compared with those with white-coat hypertension.

Comment: These findings confirm that white-coat hypertension is associated with a more favorable prognosis than is sustained hypertension. However, before white-coat hypertension can be deemed benign, further studies are needed to show that the prognosis in patients with untreated white-coat hypertension does not differ from that in controls.

— H Calkins

Published in Journal Watch Cardiology January 15, 1999

Citation(s):

Khattar RS et al. Cardiovascular outcome in white-coat versus sustained mild hypertension: A 10-year follow-up study. Circulation 1998 Nov 3 98 1892-1897.

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